Provider Demographics
NPI:1235865551
Name:EMERALD COAST DENTAL SLEEP SOLUTIONS, INC.
Entity Type:Organization
Organization Name:EMERALD COAST DENTAL SLEEP SOLUTIONS, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MS
Authorized Official - First Name:AMIE
Authorized Official - Middle Name:J
Authorized Official - Last Name:MCMULLEN
Authorized Official - Suffix:
Authorized Official - Credentials:CRDH
Authorized Official - Phone:850-479-3355
Mailing Address - Street 1:6160 N DAVIS HWY STE 6
Mailing Address - Street 2:
Mailing Address - City:PENSACOLA
Mailing Address - State:FL
Mailing Address - Zip Code:32504-6967
Mailing Address - Country:US
Mailing Address - Phone:850-479-3355
Mailing Address - Fax:
Practice Address - Street 1:6160 N DAVIS HWY STE 6
Practice Address - Street 2:
Practice Address - City:PENSACOLA
Practice Address - State:FL
Practice Address - Zip Code:32504-6967
Practice Address - Country:US
Practice Address - Phone:850-479-3355
Practice Address - Fax:850-479-3377
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-07-28
Last Update Date:2022-09-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty
No332BC3200XSuppliersDurable Medical Equipment & Medical SuppliesCustomized EquipmentGroup - Single Specialty